Provider Demographics
NPI:1346228582
Name:STRUCK, TERESA (TERRY) (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA (TERRY)
Middle Name:
Last Name:STRUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER PT, STE 123
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5700
Mailing Address - Country:US
Mailing Address - Phone:719-577-9090
Mailing Address - Fax:719-577-4549
Practice Address - Street 1:1633 MEDICAL CENTER POINT
Practice Address - Street 2:SUITE 123
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5700
Practice Address - Country:US
Practice Address - Phone:719-577-9090
Practice Address - Fax:719-577-4549
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27509208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275098Medicaid
COC504198Medicare PIN